To the Editor: The very high mortality resulting
from epidemics of cholera and dysentery among Rwandan refugees in Goma, Zaire,
in 1994 was a turning point for humanitarian aid organizations. Wide-scale
clinical mismanagement of cholera by inexperienced relief workers was reported
in both the scientific literature1 and in
the news media. Prior to this time, many humanitarian organizations had recognized
the need to improve professional standards within their own organizations
to improve the effectiveness of their humanitarian response. Events in Goma,
however, increased the impetus to improve accountability within the humanitarian
system as a whole.2